Provider Demographics
NPI:1538262795
Name:INDIANA CENTER FOR PRENATAL DIAGNOSIS, PC
Entity type:Organization
Organization Name:INDIANA CENTER FOR PRENATAL DIAGNOSIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LENKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-846-6775
Mailing Address - Street 1:PO BOX 68952
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0952
Mailing Address - Country:US
Mailing Address - Phone:317-802-3119
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:6845 RAMA DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1707
Practice Address - Country:US
Practice Address - Phone:317-846-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200889210Medicaid
IN200889210Medicaid